Blood Sample Cold Transportation Record Form
General Information
Sender Name/Facility
Recipient Name/Facility
Date of Transit
Type of Sample(s)
Number of Samples
Method of Transportation
Packaging Description
Name of Transport Handler
Temperature Monitoring Log
Time
Temperature (°C)
Checked By
Remarks
Time of Arrival
Condition of Sample at Arrival
Received By (Name/Signature)
Additional Remarks